Tuesday, May 15, 2012

Tuesday -- Almost Outta Here!

Today's my last full day before I head out to Los Angeles for my favorite trip of the year, Mike McCready's Flight to Mars benefits for CCFA and Advocacy for Patients. In the past, Mike has played one show in Seattle. However, because this is the 10th year of the Flight to Mars shows, Mike and his wife Ashley have organized a mini-tour, seven shows on the West Coast. I'll be there for the LA bash, and then spend a couple of days with Mike and Ashley before heading home. It's going to be hard -- when I planned this trip, I had a staff attorney who would be covering the office for me. Now that she left without notice, and my new wonderful staff attorney doesn't start until I get back, I'll be returning calls from the road, which can be a challenge, especially with the time difference. But I'll do my best -- and hope, perhaps, things will quiet down a bit.

The phones have been terribly busy lately, and most of the calls are substantive cases that require my intervention. The quick questions seem to have grown into bigger deals. I think this month will be our busiest ever for school cases. I don't know what's going on -- why schools seem determined to fight, even over accommodations that don't cost money. I have a load of cases involving absenteeism due to illness, and threats to withhold graduation as a result. A really big deal for these kids -- and an outrage when the students have passed all of their classes and done everything asked of them other than showing up to school sick. I really don't get it.

Oh, well. I guess I might as well turn to the news for some more things I don't get!

Even as the United States is split about efforts to extend health care to all, there is a global push towards universal care that is leaving us behind. China is doing it. Mexico too. If we abandon health reform -- if the Supreme Court strikes it down or if the GOP succeeds in repealing it -- we will be an outlier, one of the few countries remaining that does not ensure that its citizens have access to health care. That health care costs way more here, too. Health care will become (if it isn't already) the issue that separates the haves from the have nots. We must keep fighting to stop this sort of class warfare that really means life and death -- and that sacrifices the lives of people with chronic illnesses just because we were unlucky enough to get sick.

Insurance company denials of coverage are not all about money. Here's an example. Traditionally, chemotherapy was given intravenously (IV). So not only did the insurer have to pay for the drug, but it had to pay for the infusion, which included a facility fee for the hospital. Big bucks. But the newest cancer drugs are in pill form. You'd think insurers would be happy not to have to pay for an infusion and all that that entails. However, they're making it much harder on people to take these new drugs, placing them on specialty tiers, so instead of paying a flat dollar amount co-pay, you're paying a percentage of the cost of the drug -- far more expensive for the consumer, even though the treatment overall may be less expensive for the insurer. And while out of pocket costs for medical care are often capped annually, there's usually no cap on out of pocket costs for pharmacy charges. Some states are passing laws saying all oncology drugs have to be treated the same, but when Washington state passed such a law, Premera Blue Cross said fine, they'll treat all chemotherapy drugs the most expensive way possible, and all of a sudden, people taking chemo drugs (immunosuppressants) for Crohn's disease and other chronic illnesses were being charged $800 per month at the pharmacy instead of $30 per month. I don't think we have a fix for this yet. Part of the massive issue of specialty tiers and whether there is an equitable way to ensure patient access without breaking the bank. And by the way, the cost to insurers of covering all oncology meds the same, with a flat copay, is negligible. So really, it's not about cost.

We're going to need a lot of new primary care providers as the uninsured get insurance that allows them to see a provider. But must it be a doctor? Nurse practitioners see this as an opportunity to educate the public about what they have to offer. I've seen several nurse practitioners and physician's assistants over the years when my doctor is booked up and I have an emergency. In my experience, they've been great. I would never hesitate to see one -- except when things with my Crohn's get complicated, at which point, I don't rely on my primary care physician, either. But for routine care, check out a NP or PA next time. I bet you like it.

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